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This study involves the design, development and evaluation of a new multifunctional prosthetic mesh for treatment of abdominal wall defects without complications. The developed prosthetic mesh is a hybrid platform of both synthetic and natural materials with its backbone consisting of a synthetic commercial polyester fabric (CPF) to provide the required mechanical integrity. The CPF mesh was coated by a natural biodegradable, biocompatible and antimicrobial layer of chitosan (CS) incorporating phenytoin (PH)-loaded pluronic nanomicelles for healing promotion, and ciprofloxacin (CPX)-alginate polyelectrolyte complex-based microparticles as antibacterial agent. The prosthetic mesh was optimized and evaluated in-vitro and in-vivo. The optimum PH-loaded micelles had particle size of 95.42 nm, polydispersity index of 0.41, zeta potential of -18 and entrapment efficiency of 89.4%, while the optimum CPX microcomplexes had particle size of 1292.0 nm, polydispersity index of 0.8, zeta potential of -20.1, complexation efficiency of 81.1%, and minimum inhibitory concentration of 0.25 μg/ml and 0.125 μg/ml against Staphylococcus aureus and Pseudomonas aeruginosa, respectively. In-vivo study on abdominal wall defect dog model was conducted, followed by implantation of the proposed prosthetic meshes. The developed mesh depicted an efficient healing with excellent biocompatibility, and could be an ideal and feasible alternative prosthesis with many advantages such as low cost, inertness, mechanical stability, pliability, low infection rate, limited modification by body tissues, sterilizability, non-carcinogenicity, limited inflammatory reaction, hypoallergenic as well as minimal complications., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Due to the rarity of Grynfelt hernia, there is no standardized surgical technique.From April 2010 to September 2017, 12 cases of primary superior lumbar hernia (Grynfelt hernia) were identified through medical records reviewing and included in our study. Perioperative data, surgical outcomes, and long-term follow-up results were retrospectively analysed.Male/female ratio of patients was 1:1, with age 69.5 (62, 74.5) [median (25 percentile, 75 percentile)] years old. Right/left side ratio of lumbar hernia was 9/3. The in-hospital duration was 7 (5, 8) days. The surgical duration was 35 (30, 50) minutes. The defect size was 2.1 (1.5, 3) cm in diameter. The discharge of the patient was on 3 (2, 4) post-operative day (POD). The meshes used were: MK5816 (10), MK5810 (1), and UHS (1). There was only 1 case of postoperative complication where the patient was admitted in intensive care unit (ICU) due to hypoxemia. Morbidity, mortality, and recurrence cases were null.Our study indicates that open surgery with mesh implantation is a reliable way for the management of primary superior lumbar hernia.

Background: Incarcerated hernias represent about 5-15 % of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection., Aim: The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields., Methods: This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications., Results: Eighty-four patients (50.6 %) presented inguinal hernias, 43 femoral (25.9 %), 37 umbilical hernias (22.3 %), and 2 mixed hernias (1.2 %), respectively. Mesh was placed in 64 patients (38.5 %), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7 %), and 8 patients (4.8 %) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01)., Conclusion: Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.

Better mechanical knowledge of the abdominal wall is requested to further develop and validate numerical models. The aim of this study was to characterize the passive behaviour of the abdominal wall under three configurations: intact, after creating a defect simulating an incisional hernia, and after a repair with a mesh implanted intraperitonally. For each configuration, controlled boundary conditions were applied (air pressure and then contact loading) to the abdominal wall. 3D local strain fields were determined by digital image correlation. Local strains measured on the internal and external surfaces of the intact abdominal wall showed different patterns. The air pressure and the force applied to the abdominal wall during contact loading were measured and used to determine stiffness. The presence of a defect resulted in a significant decrease of the global stiffness compared to the intact abdominal wall (about 25%). In addition, the presence of the mesh enabled to restore the stiffness to values that were not significantly different from those of the intact wall. These results suggest that intraperitoneal mesh seems to restore the global biomechanics of the abdomen., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: Reconstruction of large, complex abdominal wall hernias is an ongoing challenge. Primary closure of such hernias is often not possible. The components separation technique (CST) is a practical option, however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we added a biologic underlay mesh and a lightweight polypropylene onlay mesh to the traditional CST., Methods: Patients with a large hernia defect with or without multiple recurrences were selected to undergo a CST augmented with an acellular porcine dermal collagen mesh underlay. Following midline abdominal closure, a lightweight, large-pore polypropylene onlay mesh was fixed to the abdominal fascia. The skin and subcutaneous layers were closed over two sump drains and two closed suction drains., Results: Fifty-one patients underwent a mesh-reinforced CST from May 2006 to June 2010. The study population averaged 57.9 ± 1.5 years of age with 24 males and 27 females, BMI of 34.3 ± 0.9 kg/m(2), ASA score of 2.62 ± 0.08, 29 % were smokers, 29 % were diabetic, and 69 % had at least one previous abdominal wall hernia repair. Operative time averaged 196.5 ± 7.2 min with a blood loss of 318 ± 24 mL, and average hernia defect size of 301 ± 31 cm(2). Length of follow-up averaged 20.6 ± 2.1 months; surgical site occurrences were identified in 39 %, most commonly from skin necrosis. Hernia recurrence rate was 3.9 %., Conclusions: Repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene onlay mesh results in lower recurrence rates compared to historical reports of CST alone.

Introduction: Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh., Methods: We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK), polyamide (PA) and a composite, gelatin coated PA (PA+G). The rat abdominal hernia model was used to implant the meshes (25 × 35 mm, n = 24/ group). After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester., Results: This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes., Conclusion: PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may provide an alternative option for future treatment of fascial defects.

Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Adhesion formation is a common adverse effect in intraperitoneal onlay mesh (IPOM) surgery. Different methods of adhesion prevention have been developed, including coated meshes and separate antiadhesive barriers (SABs). In this study one type of mesh was tested with different SABs, which were fixed to the sutured mesh using fibrin sealant. The primary aim was to compare adhesion prevention between different SABs. Secondary aims were the assessment of tissue integration and evaluation of SAB fixation with fibrin sealant., Methods: Thirty-two rats were randomized to one of three treatment groups (SurgiWrap, Prevadh and Seprafilm) or a control group (no SAB). Animals were operated on with an open IPOM technique (8 per group). One macroporous polypropylene mesh per animal (2 × 2 cm) was fixed with four non-absorbable sutures. An antiadhesive barrier of 2·5 × 2·5 cm was fixed with fibrin sealant. After 30 days, adhesion formation, tissue integration, seroma formation, inflammation and vascularization were evaluated macroscopically and by histology., Results: Prevadh and Seprafilm groups showed a significant reduction in adhesion formation compared with the control group. Tissue integration of the mesh was reduced in these groups. Fibrin sealant fixed the SAB to the mesh securely in all groups., Conclusion: Prevadh and Seprafilm are potent materials for the reduction of adhesion formation. A potential relationship between effective adhesion prevention and impaired tissue integration of the implant was observed. Fibrin sealant proved an excellent agent for SAB fixation., (Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Background: In recent years, the use of synthetic glues has become an established practice in several areas of surgical treatment. For example, they are used in open and laparoscopic surgery and in digestive tract endoscopy, interventional radiology, and vascular neuroradiology. The experiments in this study were aimed at elucidating that suture-based permanent mesh fixation can be replaced by fixation with N-butyl 2-cyanoacrylate glue (Glubran2) for surgical repair of abdominal wall hernias., Materials and Methods: In 25 Wistar rats, two hernia defects (1.5 cm in diameter) per animal were created bilaterally in the midline of the abdominal wall. The peritoneum was spared. The lesions were left untreated for 10 d to achieve a chronic condition. Then the defects were covered with TiMESH extralight (2 × 2 cm) and fixed by 30 μL of Glubran2 or traditional suture. The time points of sacrifice were 17 and 28 d, 3, 4, and 5 mo. At autopsy, histology and immunohistochemistry were performed to evaluate the inflammatory response and the presence of apoptotic cells respectively., Results: Mesh fixation was excellent in all samples at each time point. At application sites, the inflammatory reaction was mild with a small number of macrophages and vascularized connective tissue presence around glue and mesh threads. Glue residues were observed in histologic sections at each time point. No presence of apoptotic cells was found., Conclusions: This study demonstrated that Glubran2 can effectively replace traditional suture in mesh fixation without affecting tissue healing and determining a physiological inflammatory reaction at the abdominal wall site., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The inflammatory concept of postoperative abdominal hernia pathogenesis was proposed, basing on data obtained from clinico-experimental investigations and literature. The concept describes the abdominal wall defect formation, on a background of progressing inflammatory process in a cicatrix area, as an essential factor of risk for the local and systemic inflammatory reaction occurrence after hernioplasty operation, which negatively influences the wound process course. That is why it is necessary to conduct a pathogenetically based measures preoperatively and postoperatively for the wound complications prophylaxis and guaranteeing of the implant optimal integration into tissue of the abdominal wall defect.

Background: Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75-80% of hernia repair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on foreign body reaction and collagenous ingrowth., Materials and Methods: In 24 male Chinchilla rabbits, an incisional hernia repair was performed with mesh reinforcement either by sublay (n = 12) or by onlay technique (n = 12). In each group, two different types of mesh prosthesis were investigated: polypropylene (PP, Prolene) and polypropylene-polyglecaprone 25 composite (PP-PG, UltraPro). On postoperative day 60, the inflammatory and connective tissue formation was characterised by measuring the diameter of inner cellular infiltrate and outer fibrous capsule of the foreign body granuloma, and by verifying the collagen type I/III ratio. Furthermore, the expression of matrix metalloproteinase-2 (MMP-2) was analysed., Results: Microscopic investigation of the mesh/host-tissue interface showed typical formation of foreign body granuloma. The diameters of the inner part of the foreign body granuloma representing the amount of inflammatory cell infiltrate were significantly increased in the PP mesh compared to the PP-PG mesh, both in the sublay group (PP 13.1 +/- 1.21 microm vs. PP-PG 11.7 +/- 0.34 microm; P = 0.026) and in the onlay group (PP 13.1 +/- 1.24 microm vs. PP-PG 11.2 +/- 0.55 microm; P = 0.009). The diameter of the fibrous capsule as the outer ring of the granuloma was significantly increased when investigating the PP mesh in sublay position (29.5 +/- 1.12 microm) compared to the PP mesh in onlay position (27.9 +/- 0.73 microm) (P = 0.026). Investigating the quality of perifilamentary collagen deposition expressed as collagen type I/III ratio, the sublay group showed significantly elevated values compared to the onlay group (PP sublay 3.1 +/- 0.18 vs. PP onlay 2.4 +/- 0.41; P = 0.004) (PP-PG sublay 3.5 +/- 0.34 vs. PP-PG onlay 2.6 +/- 0.13; P = 0.002). The analysis of MMP-2 expression revealed no significant differences., Conclusion: The beneficial results of mesh reinforcement in the sublay technique might be due to a superior quality of postoperative connective tissue formation. Mesh incorporation, irrespective of positioning, is favourable in low-weight, large, porous mesh material represented by a reduced inflammatory part of the foreign body granuloma.

Introduction: Current studies have shown the validity of the atraumatic fixation with fibrin glue (Tissucol) compared to conventional sutures in polypropylene mesh fixation. We propose to study the behaviour of absorbable mesh., Material and Methods: We used 20 Wistar white rats. Two hernia defects were made in the abdominal wall, which were repaired using absorbable PGA-TMC preperitoneal mesh. The right side of the mesh was fixed with Tissucol and left side with conventional suture attached to the muscle fascia. One group of 10 rats were sacrificed at day 14 (Series A) and the other 10 rats at 28 days (Series B). We used two tests to assess the contingency of the abdominal wall; Pressure Test: pneumoperitoneum more than 40mmHg maintained for 1min, Traction Test: dynamometry of the affected area more than 300mg per cm(2) of traction. Abdominal wall was analysed to determine the integration of the new generation mesh., Results: The fixation of the mesh after the pressure and traction tests showed no statistically significant changes in either group. The integration of the mesh and vessel neoformation was higher in the cases of fixation with fibrin glue., Conclusions: Biological fixation with fibrin glue is similar to the conventional. Absorbable mesh was suitably integrated and vascular neoformation and integration of the mesh was also found to be better than conventional sutures when fibrin sealant was applied.

Background: The patient's own repair of a body wall defect would be enhanced by a mechanically robust, physically tailorable, bioresorbable mesh scaffold that: (1) supports rapid host tissue ingrowth and development, while (2) reducing the complications associated with permanent synthetic and allogenic and xenogenic biological implants., Methods: A full-thickness 1-cm-diameter abdominal wall defect was made in 36 Sprague-Dawley rats, which were divided according to the implant material used; SeriFascia surgical mesh (test) and Mersilene mesh (control). Histopathology, histomorphometry, tissue ingrowth, and biomechanical analysis were performed 30 and 94 days post-implantation., Results: The biological response to the test and control groups were equivalent, with significantly greater tissue ingrowth observed in the test group (P < 0.05). A significant 33 and 57% reduction of test device mass was observed at 30 and 94 days, respectively. The ultimate burst load for the test group defect decreased after 30 days to the initial strength of the control mesh and remained constant for the duration of the study., Conclusion: SeriFascia surgical mesh initially bioresorbed at an ideal rate that supported the transfer of load-bearing responsibility to developing host repair tissue. The results indicate the development of functional native tissue that could potentially minimize any long-term complication associated with presently available mesh implants.

Clinico-experimental studying the immunomorphological reactions variants in the prosthesis of anterior abdominal wall using synthetic polypropylene mesh was conducted. In 70 patients, operated on for postoperative hernia of abdominal wall using "on lay" method and the immune state were studied up by means of investigation of proinflammatory and anti-inflammatory cytokines content, in part, of tumor necrosis factor-alpha; (TNF-alpha), IL-8, IL-4. Morphological investigations were conducted in experiment on 100 the Vistar line mices, there were studied reactions of fibroblasts, macrophages, lymphocytes and leucocytes. The results of the immunological and morphological reactions on polypropylene obtained trust the necessity of differentiated approach application for the choice of the synthetic prosthesis kind, taking into account its biocompatibility, physical properties, the hernial defect size etc.

Background: Ventral hernia repair is currently performed via open surgery or laparoscopic approach., Objective: To develop an alternative ventral hernia repair technique., Setting: Acute and survival experiments on twelve 50-kg pigs., Design and Interventions: An endoscope was introduced transgastrically into the peritoneal cavity. An abdominal wall hernia was created through a 5-mm skin incision followed by a 5-cm-long incision of the abdominal wall muscles and aponeurosis. A hernia repair technique was developed in 3 acute experiments. Then animals were randomized into 2 groups. In the experimental group (5 animals) Gore-Tex mesh was transgastrically attached to the abdominal wall, repairing the previously created abdominal wall hernia. In the control group (4 animals), the hernia was not repaired. In both groups, the endoscope was then withdrawn into the stomach, and the gastric wall incision was closed with T-bars. The animals survived for 2 weeks and were then euthanized., Main Outcome Measurement: The presence of ventral hernia on necropsy., Results: In the control group, the ventral hernia was present on necropsy in all animals. In the experimental group, the ventral hernia was easily repaired, with no evidence of hernia on necropsy. In the first animal in the experimental group, necropsy revealed infected mesh. After this discovery, we used sterilized cover for mesh delivery and did not find any signs of infection in 4 subsequent study animals., Limitation: The study was performed in a porcine model., Conclusions: Transgastric ventral hernia repair is feasible, technically easy, and effective. It can become a less invasive alternative to the currently used laparoscopic and surgical ventral hernia repair.

Background: In general surgery, the repair of abdominal wall hernias has a prominent place, and the indications and uses of meshes have increased due to better results., Aim: To compare the repair of induced abdominal wall defects with Parietex and Surgisis meshes, in direct contact with abdominal viscera (intraperitoneal mesh)., Method: For the experiments, were used 16 female young adult rabbits. Two full thickness triangular defects of 2 cm base by 2.5 cm high were created, lateral to the linea alba, one at each side. They were repaired with rectangular meshes of 3 cm base by 3.5 cm high, on the right side with Parietex mesh (polyester/collagen-polyethylenglycol-glycerol), and on the left side with Surgisis mesh (lyophilized porcine small bowel submucosa). The evaluation included clinical-surgical findings as well as histological and immunohistochemical parameters. Eight rabbits were subjected to euthanasia after 30 days, and the eight after 60 days., Results: Both meshes induced skin erosions, despite the varying levels of mesh undermining evaluated, no incisional hernia occurred. There were peritoneal adhesions to the surface of both types of meshes after 30 days and in a lower extent and intensity after 60 days. Meshes' shrinking correspond to 1/3 of the original size and Parietex caused less inflammatory process at the histologic evaluation. Deposition of collagen type I presented no significant difference between the meshes, but deposition of collagen type III was more intense after 60 days, in both groups. Regarding collagen's rearrangement, the production of MMP8 was higher on Parietex after 30 days, and MMP13 enzyme was increased after 60 days, in both meshes (significant only for Parietex)., Conclusion: Both meshes were efficient in the correction of abdominal wall defects, and with similar results, but Parietex presented less inflammatory process and greater amount of matrix-metalloproteinases MMP8 and MMP13 than Surgisis.

Background: Over the years, reticular prostheses have undergone changes in their structure and composition to give rise to today's partially absorbable lightweight meshes. This study was designed to assess the biological and biomechanical behavior of these prostheses to establish whether they offer any advantages over nonabsorbable lightweight polypropylene prostheses., Materials and Methods: 7 x 5 cm defects were created in the anterior abdominal wall of New Zealand White rabbits and repaired by securing different prostheses to the edges of the defect with a running 4/0 polypropylene suture. The lightweight biomaterials compared were two nonabsorbable meshes: Parietene and Optilene elastic, and two partially absorbable prostheses: Vypro II and Ultrapro. At 14 and 90 days postimplant, tissue/prosthesis specimens were subjected to histological, immunohistochemical, shrinkage, and biomechanical analyses., Results: Adhesion formation on the peritoneum-facing surface of the meshes was significantly less extensive in the meshes with absorbable components at 90 days postimplant. The newly formed tissue around the prosthetic filaments was comprised of collagen fibers, fibroblasts, blood vessels, and macrophages. The partially absorbable meshes showed higher macrophage proportions (due to remnants of absorbable material and their structure) than the nonabsorbable meshes at 90 days, although differences were not significant. At 90 days postimplant, similar tensile strengths were recorded for all the implants., Conclusions: All the prosthetic materials induced good host tissue ingrowth, with no significant differences in tensile strength observed. Our findings suggest that partially absorbable lightweight prostheses could offer advantages over nonabsorbable lightweight meshes since less foreign material persists in the recipient, improving abdominal wall compliance.

A variety of negative opinions about repeated usage of relatively expensive resterilized synthetic meshes have been considered. It had been stated that resterilized polypropylene meshes inhibits fibroblastic activity, decreases proliferative activity, and increases apoptosis in human fibroblast culture, in vitro. The purpose of this study is the in vivo evaluation of the resterilized mesh repairs of abdominal hernia defects in rat models of incisional hernia by comparing primer repair and original mesh repairs. The rats (n = 22) were separated into three groups. While the abdominal defect was repaired by primary suture in the control group (CG), the defects were repaired by original mesh (OG) or resterilized mesh (RG) in mesh-repaired groups. After 21 days, the rats were evaluated for tissue tensile strengths, tissue hydroxyproline levels, tissue inflammation, fibrosis, and apoptosis. Although the tensile strengths in OG and RG were significantly higher than those of CG (p < .05 and p < .05), there was no significant difference between two groups. The tissue hydroxyproline levels in OG and RG were also higher than those of CG. The difference was not significant between the two groups. The inflammation and fibrosis indexes in OG and RG were significantly higher than those of CG (p < .0001 for both), but there was no difference between groups. While the apoptosis index in OG and RG was also higher than that of CG (p < .0001 for both), there was no significant difference between OG and RG. The usage of resterilized mesh in abdominal wall repair did not reduce the tissue tensile strength, did not affect the tissue hydroxyproline levels, did not decrease the fibrosis, and did not increase the tissue inflammation and apoptosis. In conclusion, usage of resterilized meshes in abdominal wall defects was as safe as sterilized meshes.

Background: Placement of an intraperitoneal prosthetic is required for laparoscopic ventral hernia repair. The biocompatibility of these prosthetics determines the host's inflammatory response, scar plate formation, tissue ingrowth, and subsequent mesh performance, including prosthetic compliance and prevention of hernia recurrence. We evaluated the host response to intraperitoneal placement of several prosthetics currently used in clinical practice., Methods: A 4-cm x 4-cm piece of mesh was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included expanded polytetrafluoroethylene (ePTFE) (DualMesh), ePTFE and polypropylene (Composix, heavyweight polypropylene), polypropylene and oxidized regenerated cellulose (Proceed, midweight polypropylene), and polypropylene (Marlex, heavyweight polypropylene). At four months, standard hematoxylin and eosin and Milligan's trichrome stains of the mesh-tissue interaction were analyzed by three observers blinded to the mesh types. Each specimen was evaluated for scar plate formation, inflammatory response, and tissue ingrowth. Each of these three categories was graded on a standard scale of 1-4 (1 = normal tissue and 4 = severe inflammatory response). The scores were analyzed using Wilcoxon rank sum test with p < 0.05 as significant., Results: Ten samples of each mesh type were evaluated. There was no difference in tissue incorporation between the groups. The mean scar plate formation was greater in the heavyweight polypropylene meshes than for DualMesh (p = 0.04). With Proceed, the reduction in scar plate formation compared with that for Composix and Marlex approached statistical significance (p = 0.07). The mean number of inflammatory cells was greater around the ePTFE when compared with the midweight polypropylene (p = 0.02) but equal to the other meshes., Conclusions: The four prosthetic materials evaluated in this study demonstrate comparable host biocompatibility as evidenced by the tissue ingrowth. Scar plate formation around DualMesh was significantly less than that around Composix and Marlex. Interestingly, more inflammatory cells were noted surrounding the DualMesh which was equal to that of the heavyweight meshes. Proceed, a midweight polypropylene mesh, has the potential for improved patient tolerance compared to heavyweight polypropylene meshes based on its favorable histologic findings.

Incisional hernias due to trauma, infection, or tumor are a common abdominal wall defect. Repair of these defects when autogenous tissue is insufficient or inadequate often results in abdominal tissue adhesion. These adhesions often lead to complications such as intestinal obstruction and enterocutaneous fistula. Previous reports have shown that application of prosthetic materials, such as polypropylene mesh and anionic polysaccharides, has been effective in reducing the amount of tissue adhesion. However, some tissue adhesion still occurs with application of these materials when previously described methodologies are used. We evaluated the efficacy of a novel surgical approach that combines the application of Sepramesh, a coated polypropylene mesh, and Seprafilm, composed of anionic polysaccharides (both products from Genzyme, Cambridge, MA), in the repair of abdominal wall hernias. We report that combined application of these 2 materials in a "sandwich technique", by placing the peritoneum between the Seprafilm and Sepramesh, further reduces (and in some instances prevents) tissue adhesion after abdominal wall defects in mice. Moreover, our combined treatment markedly decreased tissue inflammation after hernia repair.